Any Experience Using Straumann 6mm When You Cannot Do a Sinus Lift?

If you have the width I would look into megagen rescue implant. If you must go short than be wider to handle occlusal forces. Plus it's a bone level implant so 6mm buys you 6mm unlike tissue level which will be around 4.5mm. Option 2 summers lift and place 8-10 mm length implant.

Ummm you mean #2?

hi, theres always risk in placing shorter implants ,and mainly in maxilla which has low bone density.so, go for sinus lift either direct /indirect and place long and wide implant 6.0/10.0.

Check out the "Webcast Replays" section on the Bicon.com site. Bicons are invaded by Haversion bone, not the soft, cancellous bone. They now have a very good placement/insertion instrument (not on videos yet) that engages the T shaped healing abutment(keeps implant from falling into sinus) after the abutment is connected to the implant BEFORE it is placed. The implants are rounded bottoms and preceded by a blood/graft mix to spread out the pressure. You may even have enough space to put in a 5x5 implant without a lift.

Additionally, a 6x5.7 would be my best guess for this case from the limited info presented. Also, it is not the end of the world if the sinus membrane gets punctured as long as you don't drive a bunch of graft material, bacteria, or an implant up there. Bicon does have a procedure for perforated membranes, though. It's pretty simple: You place a patch of collagen membrane over the socket and tuck the center in, filling it with the blood/granular graft mixture. Then you place the implant with it's attached sinus lift abutment attached to a special insertion handle which places the combo into position. The implant must be stable and not moving, but does not need intimate bone contact to osseointegrate. As long as a Bicon is held still in the clot, it will osseointegrate. Anyway, you then close the tissue over this combo after having trimmed the excess collagen membrane down to the bone surface. The finished installation is like a Tootsie Roll Pop with the Implant as the chocolate center, the graft mix as the candy coating and the membrane as the outside wrapper. John

This case is ideal for a Summers lift. With all due respect if u don't feel comfortable refer it to a specialist. A 10 mm straumann BL would be nice.

I have been using 6 and 8mm Straumann SLActive implants in posterior maxilla and mandible since 2006. Transmucosal closure and loading at 4-5 weeks. I have not had a single failure so far (TW). This has significantly reduced patient morbidity and costs. Evidence seems to be gathering pace now, and the hydrophillic surface with a 1.8 or 2.8mm collar also helps to vertically offset the abutment implant junction. Looking at the Xray, you should be able to use a 2.8mm S, giving you an implant length of 9mm. Hope that helps Shak

With all due respect, the patient should not get the lower level treatment (less than ideal)just because you are not train to give the "A" level care. Yes current data on short implants is promising, but we do not have enough long-term data on 6 mm stand-alone implants in the posterior maxilla. Do the right thing an refer...you would want the same for yourself if you were a patient.

Are you at all concerned about what appears to be active periodontal disease around the 1 and the 3. What does the rest of the dentition look like? What is the occlusion like? Before you worry about your inability or ability to perform a technical procedure you really should look at the total picture and actually treatment plan the entire case rather than worrying about stuffing a piece of titanium into an edentulous space.

While the do the right thing and refer is well taken, some patients do not want to undergo a sinus lift for various reasons and it's good to have a tx option.. I have had a few patients that have fit into that demographic. After they have been given an informed consent we have placed 4.8x 6 and 8mm with good success. Not optimal but are working for these patients.

Dr. A: - I certainly agree with Dobs in that possible furcation involvements and bone degradation on #1 and #3 may limit the longevity of any implant placed here (long or short.) This area probably has been edentulous for awhile and there is a moderate amount of vertical bone loss. You are likely to find an atrophic (maybe D4) marrow. Your clinical crown length will likely be elongated which will add additional stress to any implant placed here. In that light, your question seems to be one that most all of us often ask. Will an easier, less expensive and less invasive procedure work for this patient given the information at hand. From the previous responses, I gather that the opinion is "sometimes" yes but we (and you) sure could use more information to support that consensus. - If you do go ahead and elect to utilize a shorter implant, you will definitely save the patient some money. I would recommend that you reinvest some of that into a CT or CBCT of the area. PA films often don't dimensionally depict this area adequately. Also, they are not necessarily diagnostic of sinus disease (which should impact your decision to perform any type of lift.) You will also gain some information about densities and defects in this area. - Last week there was a very similar question on this forum under the title "Prognosis of Final Restorations when Using Shorter Dental Implants". I did make several comments there and I also made late postings yesterday and today. Included were some thoughts that may be very pertinent to your question. The last two postings may be the most beneficial. - Best of luck! - Dr. No

I swear sometimes I think these posts are a setup. Look no specialist with decent training would approach this case in this manner. First tooth #1 has an active periodontal pocket on the distal and I'm sure this patient does not need her 3rd molar so let's take that out for a start. Secondly there is so much recession on the distal aspect of #3 I have to imagine the crown to root ratio of a prospective implant in site #2 would indicate a poor prognosis with a 5 or 6mm long implant. Lastly patients trust our opinion. I don't care what a "consent" says they don't know any better. Its up to us to do the right thing. This is a sinus graft case or RPD.

Agree with Dr G above...Is this a trick question or what? Anyone really wants to put an implant between a periodontally failing #1 and #3? BAD neighborhood...Long crown, ridiculously short implant, sure, you will get a few years out of it, and then can tell the patient "tough luck...for some unknown reason, your implant did not work for too long" (a lot of guys laugh their way to the bank in the meantime...We see too much of that with dentists putting crowns on teeth with a rotten base...). Let's be serious, and stop letting your surgical limitations (and the patient's natural desire to keep everything cheap and simple) determine the appropriate treatment plan...Here it is a sinus lift, and an appropriate (10mm+) implant.

Don't do a rehabilitation of the second molar, you would better rehabilitate the posterior maxillae. Think about the periodontal disease of the area, it can contaminate your implant and that would be even more expensive and a head ache, and another point if you are planning to extract the third molar do it first before you place the implant otherwise you can hurt the area if you already have placed it. If this case had no periodontal disease you should do a sinus lift a Summers technique that is very simple and place an 8 or 10 mm length implant. Think in the area, not in the tooth. Good luck.

In this case bone height is 4 to 5 ml it minimun distance to perform internal sinus lift bone graft o summers technique.do it the procedure and placed implant longer about 10ml is better than shorter implants,if you don't want to open the sinus placed shorter implants with wide plaform. But the best is make extraction 1,3,5 open lateral window sinus lift, placed implants and bone graft because patient have bad prognostic of periodontal disease .

I do not understand. I agree with the perio disease as mentioned above but let's act if there was no perio involvement. You say you have adequate width and then say "if you can successfully do an internal sinus lift you will try". If you are doing it right you can do this. This leads me to believe you have not done any sinus lifts (lateral or internal) and do not need to be doing this if you do not understand what you are doing and how to do it successfully. This is straight forward for someone trained for this--however, this is why we go to school for an extra 3-6 years to specialize. You can not learn this in a weekend without making some of your patients "Frankenstein" in your practice. Refer to a specialist please before you get in too far over your head.

Do I see some of the same doctors expressing concern about perio dz., when we were putting complete fixed tuberosity to tuberosity implants in a 91 year old with full blown perio dz? This case may have arrested dz., Which in my opinion mandates a long implant and a sinus lift . Is it in your patients best interest to proceed with something your are not trained to do? Again, you still get to restore the implant , and the patient will probably go to sleep and have the surgery done in about 30 minutes. Internal sinus lifts are a blind surgery, aborting one of the basic principles of surgery ( visual access). Just an opinion. Bvinci

By the way, this is a perfect case for traditional sinus lift. Refer to surgeon and go watch. It is a very simple procedure.bvinci

Hello, please check the sinus before you do sinus lift and give to us a good quality panoramic rx. BEST REGARDS DOCTOR X

BV while I appreciate your comment about blind surgery I disagree about the need for a lateral window. I think it's overkill in this case. Summers technique has been proven to be effective and safe, in the right hands ofcourse.

Dr. B it's all relative, a 1 cm window , with the bony wall left intact is a mundane procedure, and more predictable. I like being able to visualize bone on the palatal and buccal aspect. The procedure takes 20 minutes , with one RN pushing meds and the second one drawing prp. Just a preference. After a day if doing hard cases it's nice to do the simple stuff to.bv

6mm straumann implants work in good bone, if you have primary stability, and if you wait long enough before loading them. In this case, however, what's the big deal using a 8-10mm wide implant? Make your osteotomy right to the membrane, make it wide enough and gently elevate, add a little bone and then use the implant to do the sinus lifting. And if you perforate 1 or 2 mm, it will heal. It's not the end of the world.

Dobs says: September 13, 2011 at 4:25 pm Are you at all concerned about what appears to be active periodontal disease around the 1 and the 3. How can you tell its active from a single PA? It could have been active 30 years ago and stable ever since.

Yeh, and when we are harvesting cranial bone to fix an orbital blow out fx, it's not a big deal to perforate the dura either, but these surgeries are all designed to avoid the violation of these spaces . So, there is no room for this flippant mentality. I guess I could have just sacrificed the ia nerve on the 19 year old female, when I removed her ameloblastoma, because the recon. And implants would have been a whole lot easier. This is what separates the " implantologist" from the surgeons! Bv

I agree with Dr. Vinci when he says that all people who place implants are not equal. We all have different knowledge bases as well as different abilities with regard to our manual skills. Most of those attributes can be improved upon with more education and experience to some finite limit. Part of the key to successful treatment is knowing those limits and utilizing others who do have advanced knowledge/abilities in areas that we don't. I believe that it is wrong to approach any case with a "so what if" attitude. But I also believe that it never wrong to consider all the "what if's". - I'd like to throw out a few thoughts that should NOT be taken as gospel, but instead, just considered for those placing implants in the maxillary posterior. First, the cortical bone here is most times thin and that the medullary bone is usually not very dense (often D4.) In cases where there is significant vertical loss, long clinical crowns are often utilized in restoration which increases loading on implants placed here. This is also an area where occlusal forces are maximized. These issues, as well as others, dictate that there is a lot working against us in attempting to restore function with implants. - Personally, I feel that evaluation of lateral or inferior sinus graft densities radio-graphically is often misleading and that we rely on them to highly. I have re-entered sinus grafts more than 6 months post-op (grafting done by myself and others) and found them to mushy and/or friable clinically, but radio-graphically they read out as D2 bone. (As an aside, I would readily concede that the graft material utilized is an important variable and not specifically considered in this finding.) From that clinical, I tend not to trust grafted sinus bone to the extent that others do. In an effort to possibly explain this, I would refer back to Dr. Roberts, in his research for NASA, who states that it takes approximately 145 days for complete skeletal turnover. Likewise, other research indicates that it may take 6 months or more for a DSL graft to fully vascularize and become viable. In that light, complete miniaturization may take a year or more - vascularization and at least one complete turn over cycle. My point is that, at least in the initial healing stages, increased implant lengths in grafted sinuses may not be the most important factor in stabilization and retention. - If not implant length, than what is most important? I would propose and ask you to consider that bi-cortical engagement (alveolar and sinus) is the most significant. Also, consider the potential for engaging more of the facial and lingual cortical bone by utilizing wider implants (i.e. 5-6mm in diameter - I credit Dr. John Manuel in another posting for that advice.) - In summary, the type of lift procedure or absolute implant length may not be the most important aspect in determining long term success. Just lifting the sinus and utilizing larger diameter implants to maximize cortical engagement "may" be the most important key factors. I would also like to add that not all implant systems and implant designs engage the alveolar cortex in the same way and to the the same degree. In that sense, I would suggest that implant choice is also a significant factor. - Thanks to anyone who read through this and all comments are welcome (positive or negative.) - Dr. No

Good points Dr. No. Boyne, et al. pointed out that if one perfs the sinus, one may expect up to 4 mm. of bone to form up along the walls of the implant. This is shape dependent on the implant. I do not advocate this for every day use. I suggest to clean up any perio, do a Sommers Lift (real easy) , place the implant and then give it 8 months. Dr. Vinci, I agree with you. I am not an OMFS and I use them when necessary, however I have learned my field.

seems nobody has commented on the apparent mucous retention cyst of the sinus apical to the planned implant site. Certainly a good case to consider CBCT and a thorough evaluation of sinus health prior to any procedure. Short implants are like mini-implants (in my opinion): there is not enough long-term clinical data to recommend them as an alternative to the standard length and diameter fixtures we have come expect good long term success with. Caveat emptor.

This radiograph is completely non-diagnostic with respect to the amount of bone height, sinus health, and/or sinus pathology. A CBCT is definitely a must prior to any final tx plan. Once the sinus is determined healthy, it would be un-just to place a 6mm implant when it is so predictable, to perform a lateral window sinus lift and evenutally placing a 12mm length implant in this site.

I totally agree when you all suggest the X-ray is non diagnostic as far as planning for an implant or assessing the obvious opacity anterior to the proposed implant sight. But from personal experience , and geographic standard of care , it is still standard of care, to proceed with this information, or lack there of. I am the only surgeon either omfs or perio in my capital city that owns a cbct scanner. After having the technology for 10 months now , I can't operate without it. Before last year I never used a ct scan with the exception of a few spiral scans when I had some steriolithigraphic models made, for implant procedures. Does anyone want to make an under wager, as to when a cbct scan will be considered the standard of care. I try to only use the scanner when I have to, but today I did 9 scans. My daily average is about 2-3. Sorry for the long winded note, but this technology parallels the invention of penicillin in the 1940s. Wouldn't dr. Flemming be flabergasted and impressed. Bvinci

Dr Dr. A. There are many comments on this thread. I will merely point out the Straumann recommendations for their 6mm long implant which I have copied from their most recent surgical manual. If you use it in this indication, you will not be following their recommendations. Kind Regards, Bill Schaeffer; 2.1.2 Specific indications for Straumann® implants with a length of 6 mm Because of the reduced surface area for anchorage in the bone, these implants are to be used solely for the following indications: As an additional implant together with longer implants to support implant-borne reconstructions. As an auxiliary implant for implant-borne bar constructions supporting full dentures in a seriously atrophied mandible.

yes i did and still do with more than 82% success rate

With absolutely no sarcasm, are you placing implants into a situation where success rates are 82 percent? Bv

Dr. Davidi..I hope you are not happy with 82% success rate in general, as if that was happening in my practice, that would be a complete failure overall. Me personally I have a success rate of 98-99% success rate, and I believe that every implant surgeon should be aiming for 97-98% plus

I've posed this question one time before with no response, so will inquire again. Has anyone used the smallest gore gtr membrane( resorbable ) that has been discontinued. It Is rigid and perfect for small defects, primarily ridge augmentations. I purchased all of their inventory and am just about out. Any suggestions as to a comparable alternative. This one is about 2.5cm by 1.5 cm. . Would appreciate any suggestions, in that I have researched the subject fairly well? Thanks bvinci

Dr X, you must understand that a panoramic X-ray has never been the standard of care , as far as assessing sinus health. Before ct scans, there was the water's view and the ap skull. Any chance anyone would answer my question about a suitable alternative to the small discontinued gore membrane, please. Bv

Please, some advice about resorbable membranes , similar to the discontinued small gore? Back to the 82 percent success vs 18 percent failure. This is unacceptable .For the sake of the entire industry , that means , that in 1000 implants, you will have 180 failures! Could you imagine these figures being thrown at you right before you go back for your coronary bypass, vp shunt or corneal transplant? Just something to think about. Bv

Hi, Dr. I have had a good experience using Bicon short implants because you can use with the implant the sinus abutment which gives a support for the implant did not get into the sinus. It realy works out real good.

You could use summers technique, wich consists in under perforation of the socket 2 - 3mm before you reach sinus cortical bone, then with specific instruments you can " hammer" up cortical Wall with some medular bone and gain around 3 - 5mm lenght and use a longer implant. By the way the surface of a short implants like 5 X 6mm its equal or bigger than a 3.75 X 10mm. Bigger surface equal bigger bone contact and osteointegration, right?